Welfare Reform on the Web (February 2010): National Health Service - reform - general

Campaign for courage underway at Mid Staffs

D. West

Health Service Journal, Jan. 14th 2010, p. 12-13

Reports on progress with improving care quality at the Mid Staffordshire Foundation Trust after appalling standards were revealed by the Healthcare Commission in March 2009. A new chief executive is working to change staff attitudes to caring and has removed senior nurses on wards that had problems. He is also working closely with campaigners who alerted the regulator to the seriousness of the problems.

Children's lives at risk as hospitals make errors with drugs

K. Devlin

Daily Telegraph, Jan. 19th 2010, p. 8

A large study which investigated errors in prescriptions given to children in five London hospitals found that one in eight contained mistakes. The research found cases where children had been given either too much or too little of a drug, where doctors had forgotten to write down how much of a drug a child should be given, or whether it should be administered as a pill or as an intravenous drip. The researchers called for a system of electronic prescribing to be introduced in hospitals which could pick up signs of mistakes.

A combined haematology and surgery clinic

C.J. Lewis and others

British Journal of Healthcare Management, vol.15, 2009, p. 586-591

The National Institute for Health and Clinical Excellence recommends that haematological malignancies should be managed within a multidisciplinary team framework. Patients exhibiting lymphadenopathy should be seen in rapid access diagnostic clinics, combining the skills of haematologists and general surgeons. This article aims to highlight the benefits of a newly implemented lymph node clinic within a district general hospital.

Could physician-assisted suicide be classified as a service under article 49 of the European Community Treaty?

B.P. Slight

Medical Law International, vol.10, 2009, p. 139-163

This paper considers whether it is possible to classify physician-assisted suicide (PAS) as a service under Article 49 of the European Community Treaty. It suggests that if PAS were to be formally recognised as a service for the purposes of EU law, it is unlikely that the UK government would be able to prevent terminally ill citizens from exercising their rights to obtain PAS in another member state. This paper demonstrates that the provision of PAS in a member state by a Dignitas-type organisation could easily fulfil the requirement of Article 49 and be recognised as a service under EU law.

The Care Quality Commission appears to be struggling with the huge task of registering every acute trust by April 1st 2010. Trusts complain that the process is chaotic, and the Commission has called in the NHS East of England chief executive, Sir Neil McKay, to help out on a part time basis.

Criticism of 'pig's ear' tendering

A. Moore

Health Service Journal, Jan. 21st 2010, p. 9

The contracts of 10 of the 'first wave' of independent treatment centres are due to expire in 2010. Those which continue to operate will offer treatment at tariff through patient choice, rather than through a block contract. The firms running the centres have also been told that they will have to go through a tender process to rent the premises they occupy from the NHS, leading to uncertainty for staff and patients.

Doctors cleared of misconduct could still be banned

M. Beckford

Daily Telegraph, Jan. 11th 2010, p. 8

It is unclear how the government's new vetting and barring scheme run by the Independent Safeguarding Authority (ISA) will integrate with professional bodies such as the General Medical Council (GMC) which regulate their members. Under the new system, professional bodies will have to report misconduct investigations to the ISA. Professionals such as nurses and doctors could be barred by the ISA even if they have been cleared by their professional body.

Doctors face skills check every 5 years

R. Smith

Daily Telegraph, Jan. 26th 2010, p. 8

Doctors are to have their skills assessed every five years to ensure they are still competent. Around 3,000 doctors on pilot schemes will begin testing the new revalidation process. An annual appraisal will be carried out by a senior colleague, with doctors expected to produce evidence of their work over the past 12 months, including training and feedback from patients and other staff. Over five years this will be built up into a portfolio so that the assessor can make a recommendation to the General Medical Council about whether the doctor is fit to practise.

Hospitals 'must cut some services to stay afloat'

S. Lister

The Times, Jan. 22nd 2010, p.5

William Moyles, who is due to step down from his role as executive chairman of the foundation trusts' regulatory body - Monitor - has said that hospitals will be faced with tough economic challenges in the years ahead. It is likely that services will be reduced, departments merged and hospital buildings sold.

Managers face professional regulation and tighter vetting

C. Santry

Health Service Journal, Jan. 28th 2010, p. 4-5

In the wake of safety fears sparked by hospital scandals, the Department of Health is developing a proposal to regulate NHS managers for the first time. Some managers believe regulation could raise their prestige, but others fear ministers could make an ill-considered announcement in the run up to the 2010 general election.

Moyes takes pride in rocking the foundations

S. Gainsbury

Health Service Journal, Jan. 28th 2010, p. 12-13

Former Monitor executive chair Bill Moyes reflects on the stormy relationship between the foundation trusts regulator and the Department of Health, the lethargy shown by half of eligible hospital trusts in applying for foundation status, and the reluctance of foundation trusts to step outside of the Agenda for Change pay framework.

Patients 'at risk' from foreign doctors

R. Smith

Daily Telegraph, Jan. 21st 2010, p. 11

European Union rules mean that doctors who have qualified in the EU must be allowed to be registered to practise in the UK. The General Medical Council cannot test their language skills or professional competence. There is evidence that this is putting patients at risk.

QIPP, quality indicators and metrics

R. White and N. Bosanquet

British Journal of Healthcare Management, vol. 15, 2009, p. 609-611

The preparation of Quality Accounts and metrics is an essential requirement for all involved in healthcare in England. The authors discuss quality indicators and metrics in the areas of tissue viability and wound care.

Renewing policy to support evidence-based health care

E. Ferlie and others

Public Administration, vol.87, 2009, p. 837-851

UK evidence-based healthcare policy has been top-down, formalised and prescriptive, reflecting the New Public Management style of reform and the Department of Health's direct line management style of control, which remains deeply embedded. The National Institute for Health and Clinical Excellence makes national recommendations on which new treatments are clinically cost-effective. National Service Frameworks (NSFs) provide a nationally consistent set of evidence-based guidelines with the NHS Modernisation Agency acting as the national body with the remit to spread best practice in service improvement. This paper considers ways in which the UK evidence-based policy framework could develop in future. It stresses local capacity building rather than top-down frameworks, standardised tools and guidelines.

Rise in admissions will be 'unsustainable' for PCTs

S. Ford

Health Service Journal, Jan. 21st 2010, p. 4-5

Only 15 primary care trusts cut emergency hospital admissions between 2007/08 and 2008/09. The rest recorded an average increase of 5%. This analysis of hospital episode statistics has prompted warnings that increases in emergency admissions at this rate are financially unsustainable for the NHS as a whole.

Simplified one-stop clinic

V.C.Y. Tang and E.W.Y. Lee

British Journal of Healthcare Management, vol. 15, 2009, p. 592-596

The government initiative to reduce patient waiting times for new referrals to specialist clinics has put a significant amount of pressure on outpatient clinics. One possible solution is to reduce the number of follow-up appointments by using one-stop clinics, in order to create more spaces for new referrals. This model allows patients to receive appropriate investigation, consultation and treatment plan in one session, with care then either discharged back to the GP for follow-up or put on the elective surgery waiting list. This study sought to identify the number of patients referred to urology clinics at St Helier Hospital that would be suitable for the one-stop clinic model and to estimate how many follow-up appointments could be saved.

Since devolution in 1998, many aspects of public policy have diverged between England, Scotland and Wales, including how targets and performance assessment are used in the NHS and local government. Health inequality is an example where all three countries have recognised a need to act but approaches to performance assessment differ. Despite contrasting approaches to targets, measurement of change in health inequality indicators and performance assessment had little practical effect in England, Scotland or Wales as officials were focused on improving access to acute services and balancing budgets.

We are the party of the NHS, says Cameron

R. Winnett

Daily Telegraph, Jan. 5th 2010, p. 4

David Cameron pledged to protect spending on the NHS as he launched the first chapter of the Tories' draft election manifesto. It promises to channel more health spending to poorer areas, a new maternity service giving mothers more choice, an end to mixed-sex hospital wards when financial resources allow, and that funding will be withheld from hospitals with high rates of MRSA infections. It also proposes giving patients detailed information about the performance of their GP surgery or hospital, and linking GP pay to results.